Think Beyond Cancer

Injury and Trauma are steadily increasing in the third world becoming a major public health problem. According to the recent WHO report, by 2020 Trauma will be the third largest killer in the developing world.

Considering the magnitude of the problem little has been achieved in terms of scientific research and education in the field of Trauma Care in our country. Education and training regarding all aspects of Trauma Care including Pre-hospital, In-hospital acute care and definitive care for accident and trauma victims. Exchange of information and education through training programs will also focus on the field of Disaster Medicine.

Association For Trauma Care of India is a unique National Organization where both medical and various other professionals have come together on a common platform for the cause of Prevention of Cancer, better management of Emergency Medical Services, Rehabilitation of Trauma victims and Research related to Trauma and EMS.

Trauma-care systems in India are at a nascent stage of development. Industrialized cities, rural towns, and villages coexist with a variety of health care facilities and an almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. There is no national lead agency to coordinate various components of a trauma system. No mechanism for accreditation of trauma centers and professionals exists. Education in trauma life-support skills has only recently become available. A nationwide survey encompassing various facilities has documented significant deficiencies in current trauma systems. Some initiatives on improving prehospital systems have been seen recently. Although injury is a major public-health problem, the government, medical fraternity, and the society are yet to recognize it as a significant public health challenge.

Prehospital Care

Prehospital care is virtually non-existent in most rural and semi-urban areas in India, and implementation of the 'golden hour' concept is still an unachieved goal.5 The concept of a coordinating agency and a designated authority is restricted mainly to cities where trauma systems are operational in some form. Quite often there is an overlapping of private and public facilities and ambulance services in an urban geographical area. Gross discrepancy is seen in prehospital services between urban and rural settings, as well as between paying and non-paying patients. In the absence of guidelines and trained paramedical staff, decisions about evacuation of the victim and the choice of the destination hospital are made on an individual-case basis. These choices are often made at the behest of patients or their kin. Formal licensing to run an ambulance service is not mandatory. Ambulance services are run by a multitude of organizations including government, police, fire brigades, hospitals and private agencies. Of the facilities surveyed, 12% reported a total absence of any ambulance service. Air ambulance services are not widely available and only 4% of the surveyed systems have even minimal access to air transportation, run by private agencies. Some facilities surveyed even had to rely, at times, on waterways to transport injured victims.

The absence of minimal educational and training standards for paramedics brings in unskilled labour to handle the most delicate of tasks. Many private hospitals in large cities offer efficient prehospital care, but this covers too small an area and too small a segment of the population. No national or regional guidelines exist for triage, patient-delivery decisions, prehospital treatment plans and transfer protocols. Policies, procedures and regulations governing medical directions are in place only in some city systems.

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